Diagnostic imaging on intracranial atherosclerotic stenosis
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Diagnostic Imaging on Intracranial Atherosclerotic Stenosis. Eduardo Freire Mello Department of Interventional Neuroradiology Hospital Espanhol, Salvador - BA, Brasil [email protected] Introduction.

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Diagnostic Imaging on Intracranial Atherosclerotic Stenosis

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Diagnostic imaging on intracranial atherosclerotic stenosis

Diagnostic Imaging on Intracranial Atherosclerotic Stenosis

  • Eduardo Freire Mello

  • Department of Interventional Neuroradiology

  • Hospital Espanhol, Salvador - BA, Brasil

  • [email protected]


Introduction

Introduction

  • Intracranial Atherosclerotic Disease accounts for 6 - 10% of all Ischemic Strokes in whites, and may be responsible for 22 - 26% of all IS in Asians

  • 15% risk of recurrent stroke per year

  • Under-recognized cause of stroke

  • Recent advances on clinical and interventional treatment

  • Accurate radiological diagnosis and quantification of the lesions is crucial for treatment planning


Diagnostic imaging on intracranial atherosclerotic stenosis

  • So, non-invasive methods are required !

DSA

  • Gold-standard, but....

  • Most expensive, invasive and time consuming

  • Stroke risk of 0,7% with permanent disability


Transcranial doppler

Transcranial Doppler

  • Least invasive and expensive test

  • Highly operator-dependent

  • Low reproducibility

  • Not technicaly feasible in all patients

  • Not possible to image every vessel


Mra x cta

MRA X CTA

  • CTA is less susceptible to motion artifacts and less dependent on hemodynamic effects

  • Approach of all proximal portions of the intracranial vasculature with a proper CTA examination and processing techniques

  • Some recent studies have compared the accuracy of MRA and CTA, alone or combined, to DSA (gold-standard)....


Diagnostic imaging on intracranial atherosclerotic stenosis

  • In 2002 Hirai et al. demonstrated that:

    • MRA alone < CTA + MRA

    • MRA alone has a lower spatial resolution as compared with CTA or DSA, and can cause overestimation of stenosis

    • Accuracy of MRA + CTA ≅ DSA in measuring stenosis and detecting occlusions of the major intracranial arteries

AJNR Am J Neuroradiol 23:93-101, January 2002


Diagnostic imaging on intracranial atherosclerotic stenosis

  • In 2008 Nguyen-Huynh et al. evaluated the accuracy of CTA for Intracranial Atherosclerotic Disease, comparing to DSA:

  • CTA detected large artery occlusion with 100% sensitivity and specificity

  • For detection of > 50% stenosis CTA had 97,1% sensitivity and 99,5% specificity, and a NPV of 99,8%

Stroke. 2008; 39:1184-1188

  • In 2005 Bash et al. compared CTA with MRA, using DSA as a gold-standard:

    • CTA has a higher sensitivity, specificity and PPV for the evaluation of intracranial stenoocclusive disease

AJNR Am J Neuroradiol 26:1012-1021, May 2005


Diagnostic imaging on intracranial atherosclerotic stenosis

  • In 2007 Villablanca et al. compared MDCT Angiography to DSA for detection and quantification of small intracranial arteries, and concluded:

    • MDCT Angiography depicted 90% or more of all examined small intracranial arteries detected with DSA

    • The smallest arterial size reliably detected with CTA was 0,7mm versus 0,4mm for DSA

AJR 2007; 188: 593-602


Diagnostic imaging on intracranial atherosclerotic stenosis

  • CTA`s disadvantages

    • Radiation exposure

    • Time and skill involved in image processing

    • Use of contrast material

    • Possible venous contamination in a region of interest

    • No significant flow information


Conclusion

Conclusion

  • CTA seems to be more accurate than MRA to evaluate intracranial atherosclerotic stenosis

  • CTA can be relatively comparable to DSA and presents fewer risks, less costs, is more frequently available and is highly accurate

  • CTA may be considered as the primary study in the setting of suspected intracranial atherosclerotic stenosis


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